Medicare & Medicaid

The Kirksville center's grant arrives weeks before maternity care billing splits into separate services Jan. 1.

Physician groups in risk contracts often learn what they owe months or years after the fact. Medical Economics spoke with Najib Jai, M.D., MBA, chief operating officer of Arbital Health, about why settlements turn into disputes and how actuarial AI tracks contract performance while the year is still underway.

An FAQ for practices closing gaps in both commercial and Medicare programs

A former congressman and two health policy advocates expect shutdown standoffs to set the terms of any health care deal next year.

Coverage confusion could disrupt patient care in 2027

Maternity care's global billing package ends Jan. 1, and employed OB/GYNs paid on productivity could feel it first.

Excited for the sunset of MIPS? Brace yourself for a replacement, not a repair. Here are four steps to prepare for it.

National Association of ACOs hosts leader at fall conference.

KFF's pre-election poll found voters trust Democrats over Republicans on health care costs by 20 points, and public support for a single government plan moves sharply depending on the argument people hear.

A new University of Michigan poll finds most older adults barely review their coverage at open enrollment, and the fallout lands in the exam room and the billing office.

What happens to kidney care when Medicare’s CKCC model sunsets and LEAD begins?

MedPAC commissioners pile on Medicare’s Merit-based Incentive Payment System, a program they love to hate

Lower pay for telehealth, direct billing for NPs and PAs come up for discussion.

A NAACOS and Innovaccer survey of 116 leaders also found only 21% are tracking which of their patients have enrolled in the new chronic care model.

Are directory errors and omissions creating barriers to care for patients?

The CMS-0057 rule regulates health plans. The question that matters is: Which of your payers will be live in your EHR on Jan. 1?

CMS' proposed cuts to physician fees focus on the operating room. For the primary care physicians managing recovery after surgery, the real gap is much larger.

Health care was the only one of five sectors to cut spending commitments this spring, falling 2.8% as hospitals faced rising supply costs and physicians awaited the final 2027 Medicare fee schedule, Coupa's Business Spend Index found.

It's shared savings season and the check has arrived. Now how do physicians divide it up fairly?

From AI scribes and coding habits to the claims payers quietly cut, these are the lessons physicians can take from four days of sessions and interviews at the Medical Group Management Association's centennial meeting.

Medical Economics spoke with MGMA's Madison Hynes about the association's draft bill to ban automatic downcoding, the Patients First Act and AI-run prior authorization in traditional Medicare.

From a same-day payment cut to AI-run prior authorization in traditional Medicare, MGMA's government affairs team laid out what Washington has in store for physicians next year.

Nearly 54 percent lower costs for adults with chronic disease. Four experts on why primary care still gets under 5% of health care spending.

MGMA members described capping Medicare Advantage contracts and favoring commercial patients, while one Texas practice leader reluctantly called Medicare her best payer.

At an MGMA Government Affairs town hall, attendees raised extrapolated audits, employer plans beyond state reach and denials with no reason codes.